The No‑Exit Mental Health System: The Federal Government Puts You on Psychiatric Drugs and Never Lets You Off
Republished with permission from AbleChild.
The Federal Government is the largest funder of mental health services and psychiatric drugs, yet these same federal agencies that provide mental health services do not provide any information for safely getting off the drugs. AbleChild believes that as the largest supplier of psychiatric drugs, the federal government should also provide an “Exit plan” for deprescribing psychiatric drugs.
Medicaid and Medicare Part D treat psychiatric drugs as “must-cover” commodities: federal rules require drug plans to cover all or nearly all antidepressants and antipsychotics as protected classes, ensuring easy access and steady revenue for manufacturers. With Medicaid alone, antipsychotics generated more than 73 million prescription claims and more than 6 billion dollars in one year, accounting for roughly 9% of all Medicaid drug spending and 10% of prescriptions.
This federal psychiatric drug infrastructure is one-way: it is built to initiate and maintain long-term drug exposure. There is no parallel requirement that any prescriber, clinic, or health plan design a personalized Exit plan before starting any psychiatric medications, and no federal benefit category that funds slow, labor-intensive taper support the way it funds prescription refills.
Regulators acknowledge serious risks associated with too many of the psychiatric drugs. For example, the Food and Drug Administration’s, (FDA) black-box warnings on antidepressants note increased suicidality risk in children, teens, and young adults, and require close monitoring when treatment is started or doses are changed. Large reviews of antidepressant withdrawal find that discontinuation symptoms are common—An alarming body of meta-analyses and large-scale surveys consistently demonstrates that between one-third and nearly one-half of patients prescribed psychiatric drugs experience withdrawal effects, with a significant portion enduring severe and drawn-out symptoms. For many, these reactions are far more than discomfort—they include incapacitating dizziness, unrelenting nausea, jarring electric-shock sensations, agitation, and relentless insomnia, often rivaling or overwhelming the original condition that led to treatment.
Beyond these physical and psychological torments, the risks escalate further. Withdrawal can trigger waves of suicidal thoughts and behaviors, with evidence linking severe discontinuation—particularly of antidepressants and opioids—to suicide attempts and completed suicides. Research documents the strong association between withdrawal and heightened aggression or violence, whether due to direct drug effects, physical desperation, or drug-seeking behavior fueled by protracted suffering. These dangers are not rare complications—they are consequences faced by a non-trivial share of those attempting to discontinue psychiatric drugs, and their impact on patient safety, public health, and the justice system is profound and underacknowledged.
Yet despite clear evidence that stopping psychiatric drugs can be medically complex and dangerous, U.S. law does not guarantee access to slow tapers, compounding, or close follow-up, when patients want to come off the drugs. A few specialty guidelines now outline careful benzodiazepine tapers and warn against abrupt cessation, but they are advisory documents, not enforceable rights. In practice, patients are routinely placed on medications with known withdrawal syndromes, while being left to navigate the exit alone or with minimal support when they try to stop.
Because coverage rules privilege pills, they tilt the entire system toward chronic drug dependence instead of time-limited, skill-building care. Analyses of Medicaid spending show billions flowing to antipsychotics and other psychotropics, while non-pharmacological interventions—peer support, psychotherapy, exercise programs, housing support—remain underfunded and harder to access, especially for low-income patients. For many people, the easiest treatment to start (a prescription) becomes the hardest to leave, not because of personal weakness, but because the addictive nature of the drugs, policy and payment are designed that way.
Labeling and drugging carry deep civil-liberty consequences. Once someone is coded with a psychiatric diagnosis and placed on powerful drugs, that record can influence everything from custody disputes to employment opportunities, firearm rights, and how police and courts interpret their credibility and autonomy. The FDA’s own warnings concede that some psychiatric drugs can increase agitation, impulsivity, or suicidality in subgroups, yet these same drugs are pushed as a default requirement to be considered “in treatment.”
In effect, a patient who accepts a psychiatric label and a prescription in today’s system risks trading long-term bodily sovereignty and legal standing for short-term empty promises of symptom relief. The state and insurers guarantee an on-ramp—coverage, formularies, aggressive screening—but refuse to build a safe, resourced off-ramp. Until there is a legal right to an Exit plan and public funding for non-drug options, “choice” in psychiatric treatment in the United States remains heavily one-sided, favoring lifelong medication over informed consent. Here is AbleChild’s 10 point recommended federal psychiatric drug “exit plan.”
ABLECHILD RECOMMENDED FEDERAL PSYCHIATRIC DRUG “EXIT PLAN”
- Physicians must conduct all biological tests first to rule out any possible medical condition.
- Physicians must advise patients that the mental health diagnosis is not based in science and there is no abnormality in the brain that is the diagnosed psychiatric disorder.
- Physician must advise patient of alternative treatment other than drugs, ie. exercise, diet, and talk therapy.
- Physicians must advise patients that the pharmaceutical companies do not know how the recommended psychiatric drug works in the brain for the disorder.
- At first prescription written, physician must provide an anticipated “treatment” timeline. Start date and expected end date for each drug.
- With each prescription, physicians must provide written expectations with specific timeframes.
- Provide patient with written information about when prescription drug is anticipated to work and what specific possible life-threatening adverse events to be aware of for each prescribed drug.
- At first prescription, physicians should provide patients with return in-person appointment to review behavioral status and discussions about continuation or discontinuation of specific drugs.
- Physicians must provide detailed written information about withdrawing from each psychiatric drug and should be overseen by physicians on weekly basis.
- Three-, Six- and Nine-month physician follow-up recommend after withdrawal from all psychiatric drugs.
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AbleChild is a 501(3) C nonprofit organization that has recently co-written landmark legislation in Tennessee, setting a national precedent for transparency and accountability in the intersection of mental health, pharmaceutical practices, and public safety.
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